Department of Medicine, University of British Columbia, Vancouver, Canada.
Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada.
J Eval Clin Pract. 2021 Dec;27(6):1390-1397. doi: 10.1111/jep.13579. Epub 2021 May 8.
Unplanned hospital readmissions are common adverse events. The LACE+ score has been used to identify patients at the highest risk of unplanned readmission or death, yet the external validity of this score remains uncertain.
We constructed a cohort of patients admitted to hospital between 1 October 2014 and 31 January 2017 using population-based data from British Columbia (Canada). The primary outcome was a composite of urgent hospital readmission or death within 30 days of index discharge. The primary analysis sought to optimize clinical utility and international generalizability by focusing on the modified LACE+ (mLACE+) score, a variation of the LACE+ score which excludes the Case Mix Group score. Predictive performance was assessed using model calibration and discrimination.
Among 368,154 hospitalized individuals, 31,961 (8.7%) were urgently readmitted and 5428 (1.5%) died within 30 days of index discharge (crude composite risk of readmission or death, 9.95%). The mLACE+ score exhibited excellent calibration (calibration-in-the-large and calibration slope no different than ideal) and adequate discrimination (c-statistic, 0.681; 95%CI, 0.678 to 0.684). Higher risk dichotomized mLACE+ scores were only modestly associated with the primary outcome (positive likelihood ratio 1.95, 95%CI 1.93 to 1.97). Predictive performance of the mLACE+ score was similar to that of the LACE+ and LACE scores.
The mLACE+, LACE+ and LACE scores predict hospital readmission with excellent calibration and adequate discrimination. These scores can be used to target interventions designed to prevent unplanned hospital readmission.
非计划性住院再入院是常见的不良事件。LACE+评分被用于识别再入院或死亡风险最高的患者，但该评分的外部有效性仍不确定。
我们使用不列颠哥伦比亚省（加拿大）的基于人群的数据构建了一个 2014 年 10 月 1 日至 2017 年 1 月 31 日期间住院的患者队列。主要结局是指数出院后 30 天内紧急住院再入院或死亡的复合结局。主要分析通过关注改良的 LACE+（mLACE+）评分来优化临床实用性和国际通用性，mLACE+评分是 LACE+评分的一种变体，排除了病例组合组评分。通过模型校准和区分度来评估预测性能。
在 368154 名住院患者中，有 31961 名（8.7%）在指数出院后 30 天内紧急再入院，5428 名（1.5%）死亡（未校正复合再入院或死亡风险为 9.95%）。mLACE+评分表现出良好的校准（大校准和斜率校准与理想情况无差异）和适度的区分度（c 统计量为 0.681；95%CI，0.678 至 0.684）。较高风险的 mLACE+评分二分法与主要结局仅有适度的相关性（阳性似然比 1.95；95%CI，1.93 至 1.97）。mLACE+评分、LACE+评分和 LACE 评分的预测性能相似。
mLACE+、LACE+和 LACE 评分对医院再入院具有极好的校准和适度的区分度。这些评分可用于针对预防非计划性住院再入院的干预措施。
